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Addressing the Causes of Child Undernutrition: What Works and Why?

Child undernutrition is an “embarrassing” reality in the 21st century and the nutrition community is seeking ways to support nutrition actions more effectively, according to the authors of a new report. Dr Pat Pridmore and Professor Roy Carr-Hill, both from the Institute of Education, presented their findings at LIDC and called for a multidisciplinary approach combining short- and long-term actions to tackle the problem.

They spoke at the seminar on 20 May of the recent technical consensus on cost-effective actions that can bring quick nutritional gains, but highlighted the difficulties of implementing these measures on a large scale. They also argued that actions to bring quick gains must crucially be complemented by actions that can sustain these gains in a sustainable way. The presentation drew on their report, which synthesised evidence on what works and why in programming to reduce child undernutrition in developing countries. Nearly 60 recent evaluations and studies were assessed to compile the structured literature review which was published last month by the Ministry of Foreign Affairs of Denmark (Danida).

Impact and interventions
Dr Pridmore, a former nutritionist, emphasised the severity of child undernutrition, saying that in 2004 undernutrition was  responsible for one-third of all child deaths. She said its consequences are “irreversible” and long-term, thereby reducing human capital and economic development, and she linked adequate nutrition to achievement of six of the eight Millennium Development Goals. Pridmore listed the short-term interventions known to work, including exclusive breastfeeding, Vitamin A supplementation and iodization of salt, and said these actions could reduce nutrition-related mortality and disease burden by 25 per cent if implemented at scale in high burden countries to reach 99 per cent of the target population. Her analysis also included the long-term measures needed to address the underlying causes related to institutional frameworks and social justice, such as improving governance, raising women’s status in society and increasing community influence over decision-making.

Challenges ahead
Pridmore highlighted the need to adopt an holistic approach, recognising the importance of food and nutrition security, good child care practices, and access to health services, water and sanitation. Her recommendations also included better coordination and the creation of cross-sectoral funding streams to support an interdisciplinary approach which is currently very limited. Pridmore added: “We need to get rid of the division between short- and long-term actions and implement at scale  all the interventions which are cost effective.”

Carr-Hill’s presentation also focused on the difficulties of working across sectors. He used the example of HIV/AIDS to show how it has taken many countries 15-20 years to approach this issue in an integrated way.  Other challenges he mentioned included persuading policy-makers at the government level to take action and problems with nutrition data, particularly because of in and out migration affecting the population being studied over time.

His recommendations for research, policy and practice, ranged  from macro to micro concerns. These included ensuring international donors maintain their commitments, improving the capacity of civil society to use nutrition data to argue with the government for better policies, and involving households in decision-making processes. Carr-Hill said new research should focus on the difficulties of implementation rather than the basics of nutrition. He added: “It is embarrassing that there is child undernutrition when we  know how to end it.”

Further Reading
Pridmore, P., and Carr-Hill, R. (2009) Addressing the Underlying and Basic Causes of Child Undernutrition in Developing Countries: What Works and Why?, Copenhagen: Ministry of Foreign Affairs of Denmark
Black, R.E., Allen, L.H., Bhutta, Z.A. et al. (2008) ‘Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences’, The Lancet 371.9608: 243-260